title: Arsenic exposure and cancer mortality in a US-based prospective cohort: the strong heart study.
abstract: BACKGROUND
  Inorganic arsenic, a carcinogen at high exposure levels, is a major global health problem. Prospective studies on carcinogenic effects at low-moderate arsenic levels are lacking.
  
  
  METHODS
  We evaluated the association between baseline arsenic exposure and cancer mortality in 3,932 American Indians, 45 to 74 years of age, from Arizona, Oklahoma, and North/South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2008. We estimated inorganic arsenic exposure as the sum of inorganic and methylated species in urine. Cancer deaths (386 overall, 78 lung, 34 liver, 18 prostate, 26 kidney, 24 esophagus/stomach, 25 pancreas, 32 colon/rectal, 26 breast, and 40 lymphatic/hematopoietic) were assessed by mortality surveillance reviews. We hypothesized an association with lung, liver, prostate, and kidney cancers.
  
  
  RESULTS
  Median (interquartile range) urine concentration for inorganic plus methylated arsenic species was 9.7 (5.8-15.6) μg/g creatinine. The adjusted HRs [95% confidence interval (CI)] comparing the 80th versus 20th percentiles of arsenic were 1.14 (0.92-1.41) for overall cancer, 1.56 (1.02-2.39) for lung cancer, 1.34 (0.66, 2.72) for liver cancer, 3.30 (1.28-8.48) for prostate cancer, and 0.44 (0.14, 1.14) for kidney cancer. The corresponding hazard ratios were 2.46 (1.09-5.58) for pancreatic cancer, and 0.46 (0.22-0.96) for lymphatic and hematopoietic cancers. Arsenic was not associated with cancers of the esophagus and stomach, colon and rectum, and breast.
  
  
  CONCLUSIONS
  Low to moderate exposure to inorganic arsenic was prospectively associated with increased mortality for cancers of the lung, prostate, and pancreas.
  
  
  CONCLUSIONS
  These findings support the role of low-moderate arsenic exposure in development of lung, prostate, and pancreas cancer and can inform arsenic risk assessment.
authors.affiliation: Authors' Affiliations: Departments of Environmental Health Science and Epidemiology, Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Bloomberg School of Public Health; Departments of Medicine and Oncology, Johns Hopkins Medical Institutions, Baltimore; MedStar Health Research Institute, Hyattsville, Maryland; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC; Divison of Gynecology Oncology, Department of Obstetrics and Gynecology, Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Missouri Breaks Industries Research Inc., Timber Lake, South Dakota; Environmental Epidemiology and Cancer Unit, National Center for Epidemiology, Carlos III Institute of Health; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain; and Institute of Chemistry-Analytical Chemistry, Karl-Franzens University, Graz, Austria.
authors.forename: Esther
authors.initials: E
authors.lastname: García-Esquinas
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Francesconi
authors.forename: Walter
authors.initials: W
authors.lastname: Goessler
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Barbara
authors.initials: B
authors.lastname: Howard
authors.forename: John
authors.initials: J
authors.lastname: Farley
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
mesh_terms: D000368:Aged; D001130:Arizona / Q000453:epidemiology; D001151:Arsenic / Q000652:urine; D020261:Arsenic Poisoning / Q000453:epidemiology* / Q000208:ethnology* / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced* / Q000208:ethnology* / Q000401:mortality / Q000652:urine; D009658:North Dakota / Q000453:epidemiology; D009825:Oklahoma / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013023:South Dakota / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D001151:Arsenic